At what age can you start hormone replacement therapy?

At what age can you start hormone replacement therapy?

The age at which someone can start hormone replacement therapy (HRT) depends on several factors, including the reason for needing HRT, the types of hormones being replaced, and the person's overall health.

For transgender patients, HRT may be started at different ages:

• For transgender youth, treatment guidelines generally recommend starting HRT around age 16, but it may be started earlier in some cases after careful assessment by a specialized gender care team.


• For transgender adults, there is no specific age requirement to start HRT. It can be started whenever a person decides it is appropriate for them following an assessment by their doctor.

For non-transgender patients needing HRT, such as for menopause or andropause, the timing depends on when hormone levels start declining and symptoms develop, which can vary by individual. In general:

• Menopausal hormone therapy is typically started around the time of menopause, usually in a woman's late 40s or early 50s. It may also be started earlier if a woman experiences premature ovarian failure.


• Andropausal hormone therapy may be initiated for men in their 40s, 50s or 60s when they develop symptoms associated with testosterone deficiency.

Regardless of the reason for initiation, the decision of when to start HRT should be made jointly by the patient and their healthcare provider after considering the potential benefits and risks specific to that person. An evaluation of the patient's medical history and hormone testing are generally conducted beforehand to help inform the decision.

The typical process for starting HRT may include:

• Initial consultation visit to review symptoms, medical history, lifestyle factors, and goals of treatment


• Physical exam and blood tests to evaluate current hormone levels and overall health


• Discussion of treatment options and formulation of an appropriate HRT regimen


• Follow-up visits to monitor progress and adjust the dosage or formulation as needed

The healthcare provider may also review special considerations like risks and benefits of different delivery methods (oral, transdermal patch, injection, etc.) and types of hormones. For example, the risks and benefits may differ for:

• Estrogen alone vs. combination estrogen progestogen


• Bioidentical vs. synthetic hormones


• Different types, doses and routes for testosterone therapy

It is important when starting HRT for non-transgender patients to:

• Use the lowest effective dose to relieve symptoms


• Take hormones cyclically or intermittently, when appropriate


• Re-evaluate the need for HRT at least annually through lab work and symptom reviews

The risks versus benefits of long term HRT use should be weighed given the patient’s individual health profile and needs. Shared decision making between patient and provider on if and when to start HRT is key.

In summary, while no single age threshold exists for initiating HRT, factors like the underlying reason for treatment, patient preferences and close medical guidance help determine what is appropriate on a case-by-case basis. Hormone levels, symptoms, medical history and goals of therapy all play a role in deciding if and when to embark on HRT.